Diseases of the Nervous System

Meningitis Haemophilus influenzae meningitis:

leading cause of bacterial meningitis in children under 5 years of age. It occurs most frequently in children from 1 month up to 4 years with a peak at 6 to 9 months.

The infection usually spreads from somewhere in the respiratory tract to the bloodstream and then to the meninges (the membranes that cover the brain). At the meninges, the bacteria produce infection and inflammation causing serious illness and sometimes death

Symptoms    Irritability, poor feeding in infants Fever (in young infants the temperature

may actually be below normal) Severe headache (older children) Nausea and vomiting Stiff neck or pain in neck when flexed Pain in back when neck is flexed

foreward and chin brought toward chest (older children)

Unusual body posturing Photophobia

Complications    Roughly 20% of patients may experience

some hearing loss. Some patients will have brain damage,

which can include seizures, mental retardation, hydrocephalus ("water on the brain"), learning disorders, abnormalities in speech and language development, and behavioral problems

Meningococcal Menigitis: infection caused by the bacterium

Neisseria meningitidis that causes inflammation of the membranes covering the brain and spinal cord.

The death rate ranges from 5% to 15%, with young children and adults over 50 having the highest risk of death.

Symptoms: Rash, pinpoint red spots

(petechiae) Complications :

Brain damage Shock Increased spinal fluid

pressure Myocarditis (inflammation

of the heart) Hydrocephalitis (blockage

of spinal fluid in brain) Deafness Paralysis of various muscles Mental retardation

Pneumococcal meningitis: Streptococcus pneumoniae is the most common

cause of meningitis in adults, and the second most common cause of meningitis in children older than 6 years old.

Prevention    Early treatment of pneumonia and ear infections

caused by pneumococcus may decrease the risk of meningitis. There are also two effective vaccines on the market to prevent pneumococcus infection.

The current recommendations are for people at high risk for pneumonia, children, and everyone over the age of 55 to be vaccinated.

Treatment    Antibiotic therapy should be started as soon as

possible. Ceftriaxone is one of the most commonly used antibiotics.

If antibiotic resistance is suspected, vancomycin or

rifampin are used. Prognosis   

With early treatment, the outcome is better. However, 20% of people who contract this disease will die of it and 50% have serious long-term complications

Leprosy Alternative names: Hansen's disease    

An infectious disease, known since Biblical times, which is characterized by disfiguring skin lesions, peripheral nerve damage, and progressive debilitation.

Causes, incidence, and risk factors   Leprosy is caused by the organism Mycobacterium leprae. It is a difficult disease to transmit and has a long incubation

period, which makes it difficult to determine where or when the disease was contracted.

Children are more susceptible than adults to contracting the disease.

2 common forms tuberculoid and lepromatous,

Both forms produce lesions on the skin lepromatous form is most severe, producing large disfiguring

nodules. All forms of the disease eventually cause peripheral neurological

damage (nerve damage in the extremities) manifested by sensory loss in the skin and weakness of the muscles.

People with long-term leprosy may lose the use of their hands or feet due to repeated injury which results from absent sensation.

Leprosy is common in many countries in the world, and in temperate, tropical, and subtropical climates.

Approximately 100 cases per year are diagnosed in the United States. Most cases are limited to the South, California, Hawaii, and U.S. island possessions.

Effective medications exist, and isolation of victims in "leper colonies" is unnecessary.

The emergence of drug-resistant Mycobacterium leprae, as well as increased numbers of cases worldwide, have led to global concern about this disease.

Symptoms include: one or more hypopigmented skin lesions that

have decreased sensation to touch, heat, or pain

skin lesions that do not heal after several weeks to months

numbness or absent sensation in the hands and arms, or feet and legs

Muscle weakness resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)

Treatment    Medications used to eliminate the microorganism

and to reduce symptoms include: Dapsone Rifampin Clofazimine Ethionamide Aspirin, prednisone, or thalidomide are used for the control

of inflammation (e.g., "erythema nodosum leprosum") that may occur with therapy

Expectations (prognosis)    Early recognition is important. Early treatment limits

damage by the disease, renders the person noninfectious, and allows for a normal lifestyle.

Complications    permanent nerve damage cosmetic disfigurement

Polio Symptoms   

There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic.

Most (95%) are subclinical infections, which may go unnoticed.

Clinical poliomyelitis affects the central nervous system (brain and spinal cord) and is divided into nonparalytic and paralytic forms.

It may occur after recovery from a subclinical infection.

SUBCLINICAL INFECTION: no symptoms, or symptoms lasting 72 hours or less

Slight fever

headache general discomfort or uneasiness (malaise) Sore throat red throat vomiting

NONPARALYTIC POLIOMYELITIS symptoms last 1 to 2 weeks Moderate fever headache Stiff neck vomiting diarrhea Excessive tiredness, fatigue irritability pain or stiffness of the back, arms, legs, abdomen muscle tenderness and spasm in any area of the body Neck pain pain front part of neck Neck stiffness Back pain or backache Leg pain (calf muscles) Skin rash or lesion with pain muscle stiffness

PARALYTIC POLIOMYELITIS fever, occurring 5 to 7 days before other symptoms headache stiff neck and back Muscle weakness, asymmetrical Abnormal sensations (but not loss of sensation) of an area sensitivity to touch, mild touch may be painful Difficulty beginning to urinate constipation Bloated feeling of abdomen Swallowing difficulty Muscle pain Muscle contractions or muscle spasms, particularly in the calf, neck, or

back drooling Breathing difficulty irritability or poor temper control positive Babinski’s reflex

Treatment    The goal of

treatment is to control symptoms while the infection runs its course.

Tetanus: A disease caused by the toxin of the bacterium Clostridium tetani that affects the central nervous system, sometimes resulting in death. Infection begins when the spores are introduced into

an injury or wound. The spores germinate, releasing active bacteria that

multiply and produce a neurotoxin, called tetanospasmin.

Tetanospasmin selectively blocks inhibitory nerve transmission from the spinal cord to the muscles, allowing the muscles to go into severe spasm.

Prevention    Tetanus is completely preventable by active tetanus

immunization (vaccine). Tetanus immunizations are begun in infancy as a

series of DPT shots (D = diptheria, P = pertussis or whooping cough, and T = tetanus).

Boosters are given to teenagers and older adults as Td shots (adult tetanus and diphtheria) or singly as just tetanus.

Immunization is considered to provide protection for ten years.

Studies in the army suggest that good protection persists up to 12 years after the last immunization.

Symptoms    spasms and tightening of the jaw muscle (hence the

name lockjaw) Stiffening of the neck and other muscles Spasms of the neck and other muscles Stiffness of the chest muscles Stiffness of the abdominal muscles (abdominal

stiffness) Spasms and stiffness of the back muscles, often

causing arching (opisthotinosis) Tetanic seizures (painful, powerful bursts of muscle

contraction) Irritability fever

Treatment    Control and reverse the tetany with antitoxin, tetanus immune

globulin. Penicillin can be given to kill the Clostridium tetani; other

antibiotics such as clindamycin, erythromycin, or metronidazole can be used in patients who are allergic to penicillin.

Remove and destroy the source of the toxin through surgical exploration and cleaning of the wound (debridement).

Treat symptoms with supportive therapy. Muscle spasms can be treated with muscle relaxants such as

diazepam.  Bedrest with a non-stimulating environment is also

recommended (dim light, reduced noise, and stable temperature).

Sedation may be necessary to keep the affected person quiet.  Respiratory support with oxygen, endotracheal tube, and

mechanical ventilation may be necessary.

Botulism

Signs and Symptoms:Infant botulism is usually seen in children under 6 months of age. The children may receive medical attention because of

symptoms such as constipation, poor sucking action, a weak cry, and a general,

progressive muscle weakness.

Description: Infant botulism is caused by Clostridium bacteria that

live in soil and dust. These bacteria may also contaminate foods,

especially honey.  Clostridium bacteria produce a toxin (poison) called

botulinum toxin, which blocks the normal messages between muscles and nerves and affects muscles everywhere in the body.

The toxin usually affects intestinal muscles first. Infant botulism occurs worldwide, and 98% of cases

occur in infants between 1 to 6 months of age. In the United States, most cases of infant botulism

cannot be prevented, since the spores of Clostridium bacteria are found in soil everywhere.

Duration: Infants with infant botulism may require hospital-

based support for an extended period. In severe cases of infant botulism, the child may

require several weeks of hospitalization and even respiratory support.

Contagiousness: No special isolation or precautions are needed since

this infection is not transmitted from person to person.

Prevention: Most cases of infant botulism cannot be prevented. Parents can eliminate one risk factor by not feeding

honey to children under age 1 year.

Professional Treatment: Doctors make the diagnosis of infant

botulism by checking the infant's stool for Clostridium bacteria or Clostridium botulinum toxin.

A child with infant botulism is treated in a hospital, usually in an intensive care unit.

Botox: Botulinum toxin type A (BOTOX®) and botulinum toxin type B

(MYOBLOC(™)) are purified substances derived from a bacteria that blocks the nerve signals from the brain to the muscle. By injecting very tiny amounts into a specific facial muscle, only the impulse of that muscle will be blocked, causing a local relaxation and weakness.

In this way, botulinum toxin acts as a muscle blockade to immobilize the underlying cause of the unwanted lines and prevent "wrinkly" expressions.

Botulinum toxin type A (BOTOX®) has been used since 1980 to treat many muscle disorders, such as lazy eye, and uncontrolled blinking.

It was pioneered by dermatologic surgeons for cosmetic use in 1987.

The FDA has granted approval to botulinum toxin type A (BOTOX® COSMETIC) for the temporary improvement in the appearance of moderate to severe glabellar vertical lines in adult men and women 65 or younger.

The approval specifically applies to the vertical lines between the eyebrows.

Botulinum Toxin Therapy Treatment involves injection of very small amounts of

botulinum toxin into the underlying muscles to relax them. The actual treatment is well tolerated and takes just a few

minutes with no "down time" or prolonged recovery period.

Botulinum toxin takes effect about 3 to 7 days after treatment.

The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns.

It is anticipated that the average patient will require reinjection at various intervals.

With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.

Other Applications Excessive sweating can be treated with injections

of a highly diluted form of botulinum toxin directly into the underarm skin, or skin on the palms of the hand and soles of the feet.

There it paralyzes the sweat glands of the skin, which are responsible for excessive perspiration.

A single treatment session can provide months of relief, and experts believe that injections can be repeated indefinitely once or twice a year to maintain dryness.

Are there any side effects? Side effects are minimal and typically relate to the local

injection. Soreness or mild bruising, while uncommon, may occur

around the injection site. Makeup may be worn after treatment, but care should be

taken to avoid pressing or massaging the area for several hours.

A temporary headache is not uncommon after injections in the forehead area, especially after the first treatment.

In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid.

All of these possible effects are likely to be mild and temporary, and in most cases, do not significantly limit routine activities.

Rabies: fatal encephalitis Caused by rabies virus Contracted through bite of infected animal

Bats, dogs, cats, rabbits, raccoons,

Once virus enters nerves it is not accessible to immune system until destroys CNS cells

Symptoms: Preliminary symp. Are mild and varied

Resemble many other infections

When CNS becomes involved person alternates between agitation and calm

Muscle spasms of mouth and pharynx

2 forms of rabies: Furious rabies: restless, then become excitable and

snap at anything Humans will sometimes bite too

Paralysis sets in and flow of saliva increases Nervous control is progressively lost Paralytic rabies: only minimal excitability Animal or person remains relatively quiet and

unaware of surroundings A form of paralysis that is transient but sometimes

fatal

Treatment: injections or immunoglobulin and antirabies vaccine

Cryptococcus Meninigitis: A rare fungal infection

caused by inhaling the fungus, Cryptococcus

neoformans

Symptoms    Chest pain Dry cough Headache nausea confusion Blurred vision or double vision (diplopia) Fatigue Fever Unusual and excessive sweating at night Glands, swollen WITHOUT nearby areas appearing

infected (e.g., red, painful, swollen) Prolonged bleeding, bruising easily

Skin rash may be present o Skin rash or lesion pinpointed rash (petechiae) o Bleeding into the skin o Bruises Unintentional weight loss Appetite, loss Abdominal fullness prematurely after meals Abdominal pain Abdomen, swollen Weakness Bone pain or tenderness of the breastbone (sternum) Numbness and tingling o Nerve pain or pain along the path of a specific nerve Pain along a nerve root (major pathway from the spinal cord

Treatment    Some infections require no treatment. However,

medical observation should continue for a year to detect any progression of the disease. If pulmonary lesions are present or the disease spreads, antifungal medications are prescribed, and treatment with these agents may be prolonged.

Medications include: Amphotericin B Flucytosine Fluconazole